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Peplau’s Interpersonal Relations Theory
Hildegard E. Peplau (1909-1999) was an American nurse who specialized in the field of psychiatric nursing (Nelson, 2013). In 1943, Peplau earned her Bachelor’s degree in interpersonal psychology (D'Antonio, Beeber, Sills, & Naegle, 2014).She served in the Army Nurse Corp where she continued to explore the field of psychiatry (D'Antonio, Beeber, Sills, & Naegle, 2014). She created the middle-range theory of interpersonal relations in 1952, which emphasizes the nurse-patient relationship (Nelson, 2013). Her main focus is mental health nursing in dealing with behaviors, personalities, and experiences. Influences Peplau's work was influenced primarily by Sigmund Freud and Harry Stack Sullivan. She would attend weekly seminars conducted by Sullivan (D'Antonio, Beeber, Sills, & Naegle, 2014). This contributed to her creation of developmental tasks associated with the stages of personality development as illustrated by Freud and Sullivan (Nelson, 2013). This was used to explain certain personalities and why people behave in various ways. Sullivan also influenced Peplau’s theory in his research regarding anxiety, self-system, and experiencing modes (Nelson, 2013). Some of the other ideas she used came from learning theory, developmental psychology, and multiple humanistic theories (Rogers, Maslow, and May) (Peplau, 1952). Peplau’s Nurse-Patient Relationship Peplau proposed that the nurse-patient relationship means to provide optimal care. She describes it as a helping relationship, where the nurse facilitates the patient’s personal growth by helping him/her identify difficulties, experience emotions, and understand his/her own behavior (Boscart, Pringle, Peter, Wynn, & McGilton, 2016). Peplau's Phases of Nurse-Patient Relationship * Orientation Phase is when the nurse establishes rapport with the patient and assists them engage in the therapeutic relationship. The patient in this phase seeks professional assistance and support from the nurse, asks questions, and shares perceptions and expectations. * Identification Phase is when the nurse encourages the patient to identify relevant issues and acts as a resource to enable the patient to access support and information. This may also include the development of nursing care plan based on the patient’s situation and goals. The patient in this phase will use the nurse to explore the issues they experience and should feel as if he or she belongs. * Exploitation/Working Phase is when the nurse develops the patient’s competences and supports their recovery. The patient will then use the nurse to problem-solve. The patient feels like an integral part of the helping environment , and make minor requests or use attention-getting techniques. This phase is the implementation of the nursing plan, taking actions toward meeting the goals set in the identification phase. *'Resolution/Termination Phase' is when the nurse supports the patient’s independence and self-care, and facilitates withdrawal of the relationship. The patient in this phase becomes free of the need for assistance and support from the nurse. This is the evaluation of the nursing process where the the nurse and the patient evaluate the situation based on the goals set and whether or not they were met. Stages of personality development Stage 1 – Learning to count on others (0-1 years) In the first stage, the infant goes through different experiences, pleasant and unpleasant. They learn to communicate in various ways with the primary caregiver, mostly the mother, in order that the care and comfort needs are met. If their comfort needs are not met, the child could experience regressive behavior. According to Peplau, when the nurses provide complete care to these patients in the form of a surrogate mother, the patient progresses towards more mature levels of functioning (Theodore, 2015). Stage 2 – Learning to delay self-satisfaction (1-3 years) In the second stage, the child learns to please others through the delay in satisfying one’s needs, such as holding the bowel and bladder to empty at appropriate places and time, which can be the first step in the development of interdependent social relationships. According to Peplau, individuals who were not able to complete stage two have potential behaviors that includes exploitation, manipulation, suspiciousness, and envy of others (Theodore, 2015). If a nurse observes such action in a patient, it is essential to encourage the child to show full expression and unconditional acceptance. Stage 3 – Identifying oneself (3-6 years) In the third stage, the child learns appropriate roles and behaviors by acquiring the ability to perceive the expectations of others. The child develops their self-concept by observing how others interact with them (Theodore, 2015). A nurse must recognize cues that communicate on how the patient feels about themselves and their current illness. Stage 4 – Developing skills of participation (6-9 years) In the fourth stage, the child learns the skills of compromise, competition, and cooperation with others establishing a more realistic view of the world and a feeling of one’s place in it. If a child fails to develop appropriate skills, they can have a hard time finding solutions to their problems (Theodore, 2015). Nurses can help patients improve their problem-solving skills so that they may achieve their resolution. Interpersonal relationship on advanced nursing practice According to Fernandes, & Nunes de Miranda (2016), "Peplau, proposes that nursing can take various roles according to the needs and specialties of each case respecting the time of the care provided" (p. 883). The theory creates an environment for nurses to assume various roles and build that nurse-patient therapeutic relationship. Collaboratively, the nurse and the patient together identify problems, find solutions, and create goals that influence the patients' actions to do better. The advanced nursing practice focuses on holistic care utilizing Peplau’s six roles utilized in the nurse-patient relationship. Stranger role: The development of professional trust in a conducive environment. The nursing career is one of the most trusted profession and nurses care for strangers on a daily basis (Nelson, 2013). The profession leads to nobility in many advance-nursing specialties. Resource person role: Patients rely heavily on nurses to interpret results and data, provide needed resources that will enhance their care, and help with the accessibility of resources (Nelson, 2013). Teacher role: Nurses wear the educator hat and has to be prepared to answer questions that patients have. Nurses strategically utilize the patients' experience and testimony to train and facilitate their learning (Nelson, 2013). Leader role: The nurse emphasizes patient-centered care and empowers patients to lead in goal setting and attaining (Nelson, 2013). Nurses promote patients’ autonomy and self-worth (Nelson, 2013). Surrogate role: Nurses advocates on behalf of their patients and help them to comprehend their dependent, interdependent and independent roles (Nelson, 2013). Nurses carry the burden and act as a buffer system between patients and other members of the healthcare team (Nelson, 2013). Counselor role: The nurse helps the patients to understand their current situation and identify a place where change can be accommodated to support current goals (Nelson, 2013). This major integration and interactions makes the patient feel supported and encouraged. '' References Boscart, V. M., Pringle, D., Peter, E., Wynn, F., & McGilton, K. S. (2016). Development and psychometric testing of the humanistic nurse-patient scale. Canadian Journal on Aging, 35(1), 1-13. http://dx.doi.org/10.1017/S0714980815000604 D'Antonio, P., Beeber, L., Sills, G., & Naegle, M. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nursing Inquiry, 21(4), 311-317. doi:10.1111/nin.12056 Exploring the characteristics of effective communicators in healthcare. (2018). Nursing Standard (2014), 33(9), 47. doi:http://dx.doi.org/10.7748/ns.2018.e11157 Fernandes, R. L., & Nunes de Miranda, F. A. (2016). Analysis of the theory of interpersonal relationships: Nursing care in psychosocial care centers. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 880-886. https://doi.org/10.5205/reuol.6884-59404-2-SM-1.1002sup201624 Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau's theory of interpersonal relations: An alternate factor structure for patient experience data? Nursing Science Quarterly, 30(2), 160–167. doi:10.1177/0894318417693286 Nelson, S. (2013). Theories focused on interpersonal relationships. In J.B. Butts, & K. L. Rich (Eds.), Philosophies and theories for advanced nursing practice (2nd ed., pp. 259-264). Burlington, MA: Jones & Bartlett Publishers. Peplau, H. (1952). Interpersonal relations in nursing. New York, NY: G. P. Putnam’s Sons. Theodore, D. D. (2015). Textbook of mental health nursing, Vol-I-E-Book. Elsevier Health Sciences.